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<br /> � C1TY OF EV�RCTT PCRM[T S�RVIC�S
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<br /> � 320Q GEDAR STf-��ET, FV�RETT, VVA 9820�
<br /> (P)42��2�7�8810 � F/ajC 4�25-257-88�7 ] {E) evereffieps@euerettwa.gov j w�w,euere�fwa.�ou/permits
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<br /> i'ROJECT ADDRESS: 4 �'j ' �,ric. . ,
<br /> BUILDIIVG AREA(if residen�ial, new consfruction,remodel, or addition) t� ' -� " �r
<br /> BUIi.aING TYPE: �5FR-D�TACHED Q S�RAT1"ACNED l7 DUPLEX ❑MULTI-FAMILY-#OF UNITS: L� COMMERCIAL
<br /> USE OF BUILDING: S' �'_ �` .
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<br /> coNT�c�r�r��c� o�woRt�:� „Li��;�cow v�
<br /> NUMBEI�O�DEVIC�S (if low volfiage}; �
<br /> �'IRE,F�I..ARt�I? ❑YES CI Nfl
<br /> ASSOGIATED BllILDING PERNIIT#(if applicable):
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<br /> I?ESGRtPTION OF�tIIOF�K: � _� �.� � � ' G-R - �
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<br /> {?iNNER NAM�:<=:. � � �� ' l . T�NANT NAME(!f Commercial):
<br /> OWNER MAIL.ING ADDRESS: srREEr 1 �'
<br /> . ._ � " - - • � -' ' " STAIE �L ZIP � i
<br /> ��iL/� �— CfIY
<br /> OWNFR PHONE: OWf�IER EMAiL; • �
<br /> C01+1TRACTORNAME; �(./I`�4� -
<br /> CDNTRACTOIZADDRESS: sraEer
<br /> C�� STA7E �P
<br /> CONTRACTOR PHONE_ 7���� GONTRAGTOR�MAIL: �
<br /> �p��}�pCTt)R llC.#(REQUIRED}: CITY OF EV�RETT BU5WES5 LIG,#(REQUIRED);
<br /> p�]�,q]�y CONTAC7':� `OWN�R � ❑CONTRACTOR L7 OTNER(Please Specify)
<br /> cf�NTACT NAME: caNTACT PHolv�:
<br /> ��lh�f��� GDNT,�CT EMAIL:
<br /> AGREEMENT.'T hereby cerfify fhat I have read and examined this application and know the same to be true and ca�ect. All ptovisions oflaws and ordrnances goveming this
<br /> iype ofwork wi11 be complefed v✓hetherspecified herein o�not. The granting of a permit does no�pre:sume to give authorify fo violate orcance/fhe provisions ofany ofherstate o�
<br /> locallawregulatin9 construcfion orthe performance ofconstrr�ction. That!am authomed 6y�he ntvneroithis properfyto perform the v�orkforwhich application ismade and l
<br /> complytvith fhe State Contracfors Law 18.27RCWand 29�200 WAC.
<br /> CifyofEveretf Official Use Only
<br /> FE�
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<br /> PERMIT#�
<br /> �,. - 5����-�,� � ��0 5 I Co a
<br /> Ow fl �ze genf Signafure Dafe (f?evrsed 90/1212095j
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